Diabetes insipidus - what it is, signs, symptoms in women and men, treatment, prognosis

Diabetes insipidus is a fairly rare endocrine disease that occurs as a result of relative or absolute deficiency of vasopressin (a non-hypophyseal hormone) and is manifested by debilitating urination (polyuria) and severe thirst (polydipsia).

We will look in more detail about what kind of disease this is - diabetes insipidus - what its causes are, symptoms in men and women, as well as what drugs are prescribed as treatment for adults.

What is diabetes insipidus?

Diabetes insipidus is a chronic disease of the hypothalamic-pituitary system, which develops due to a deficiency in the body of the hormone vasopressin, or antidiuretic hormone (ADH), the main manifestations of which are the release of large volumes of urine with low density.

The disease may begin suddenly or develop gradually. The primary signs of diabetes insipidus are increased thirst and frequent urination.

Despite the fact that there are two types of diseases with similar names - diabetes mellitus and diabetes insipidus, these are two completely different diseases, but the symptoms overlap. They are united only by some similar signs, but the diseases are caused by completely different disorders in the body.

The body has a complex system for balancing the volume and composition of fluid. The kidneys, removing excess fluid from the body, form urine, which accumulates in the bladder. When water intake decreases or there is water loss (excessive sweating, diarrhea), the kidneys will produce less urine to conserve fluid in the body.

The hypothalamus, a part of the brain responsible for regulating the entire endocrine system of the body, produces antidiuretic hormone (ADH), also called vasopressin.

With diabetes insipidus, everything that is filtered is excreted from the body. This results in liters and even tens of liters per day. Naturally, this process creates a strong thirst. A sick person is forced to drink a lot of fluid in order to somehow compensate for its deficiency in the body.

Diabetes insipidus is a rare endocrinopathy that develops regardless of the gender and age group of patients, most often in people 20-40 years old. In every 5th case, diabetes insipidus develops as a complication of neurosurgical intervention.

In children, diabetes insipidus usually has a congenital form, although its diagnosis can occur quite late - after 20 years. In adults, the acquired form of the disease is more often diagnosed.

Development factors

Among the associated factors, the following should be noted:

• traumatic brain injuries;
• brain tumor affecting the pituitary gland and hypothalamus;
• complications that occur in the early stages after brain surgery;
• genetic predisposition;
• encephalitis;
• anemia;
• metastases;
• kidney diseases.

A special variant of inherited central diabetes insipidus is Wolfram syndrome. This is the simultaneous occurrence of diabetes mellitus and diabetes insipidus, blindness and deafness. Like other hereditary forms of diabetes insipidus, this syndrome is equally common in women and men, since it is inherited autosomalally.

The essence of nephrogenic diabetes insipidus is the insensitivity of the kidneys to antidiuretic hormone (ADH). Although this hormone is produced, it does not find its use in the kidneys and the result is therefore the same as in the previous case.

Nephrogenic diabetes insipidus occurs more often after taking certain medications, such as lithium. The hereditary form of the disease is associated with the X chromosome, i.e., it predominantly affects men than women.

Gestational diabetes insipidus occurs only in women during pregnancy and is caused by the enzyme vasopressin, which is produced by the placenta. This enzyme catabolizes the breakdown of antidiuretic hormone, resulting in the same effects as in other forms of this disease. Gestational diabetes insipidus in women usually resolves within 4-6 weeks after birth.

Classification

Modern endocrinology classifies diabetes insipidus depending on the level at which disorders occur. There are central (neurogenic, hypothalamic-pituitary) and renal (nephrogenic) forms.

Neurogenic diabetes insipidus

Neurogenic diabetes insipidus (central). Develops as a result of pathological changes in the nervous system, in particular in the hypothalamus or posterior pituitary gland. As a rule, the cause of the disease in this case is surgery to completely or partially remove the pituitary gland, infiltrative pathology of this area (hemochromatosis, sarcoidosis), trauma or changes of an inflammatory nature.

In turn, the central type of diabetes insipidus is divided into:

• idiopathic - a hereditary type of disease, which is characterized by a decrease in ADH synthesis;
• symptomatic – develops against the background of other pathologies. It can be either acquired (develops throughout life), for example, as a result of a head injury or the development of a tumor. Or congenital (due to gene mutation).

With long-term central diabetes insipidus, the patient develops renal insensitivity to artificially administered antidiuretic hormone. Therefore, the sooner treatment for diabetes insipidus of this form is started, the more favorable the prognosis.

Renal diabetes insipidus

What it is? Renal or nephrogenic DI is associated with decreased sensitivity of kidney tissue to the influence of vasopressin. This type of disease is much less common. The cause of the pathology is either the structural inferiority of the nephrons or the resistance of the renal receptors to vasopressin. Renal diabetes can be congenital, or it can occur as a result of damage to kidney cells caused by medications.

Sometimes there is also a third type of diabetes insipidus, which affects women during pregnancy. This is quite a rare occurrence. It occurs due to the destruction of hormones by enzymes of the resulting placenta. After the baby is born, this type goes away.

Acquired renal diabetes insipidus in adults develops as a result of renal failure of various etiologies, long-term therapy with lithium drugs, hypercalcemia, etc.

Types of pathology

Diabetes insipidus (DI) is classified into several types, which reflect the root cause of the disease and the location of the problem.

Hormone deficiency in the body can be absolute or relative.

1. If the hypothalamus does not produce enough ADH, we are talking about the absolute value of the deficiency. The body develops a hypotholamic-pituitary or neurogenic form of the disease.
2. The second type of DI is associated with the inability of the kidneys to perceive ADH. The hormone produced in sufficient quantities cannot fulfill its purpose, and unfiltered urine leaves the body. Pathology of this type is called renal or nephrogenic.

This type of classification characterizes the location of the problem - the kidneys or the brain.

The neurogenic form is classified according to the method of appearance into two types:

1. Symptomatic - caused by acquired brain problems - inflammatory processes, unsuccessful surgical interventions, neoplasms.
2. Idiopathic - the cause is a genetic predisposition to improper synthesis of vasopressin.

The nephrogenic type of pathology is genetic in nature or is the result of acquired kidney problems. Long-term use of medications and chronic diseases of the genitourinary organs can lead to the appearance of this type of ND.

Pregnant women may develop a gestagenic type of the disease, which sometimes goes away after childbirth.

Due to the imperfections of the genitourinary system, infants are characterized by a functional type of ND.

Another type of disease is psychogenic in nature - primary polydipsia, in which uncontrollable thirst develops due to decreased production of ADH. However, if water does not enter the body, the work of the pituitary gland is normalized, and the synthesis of vasopressin is restored.

According to ICD 10, the classification of the disease occurs in two classes - the renal type has code N25.1 - this disease is classified as a genitourinary system. The neurogenic form of ND is encrypted in the class of endocrine diseases, the ICD 10 code is E23.2.

Causes

Diabetes insipidus develops when there is a deficiency of the antidiuretic hormone (ADH) vasopressin - relative or absolute. ADH is produced by the hypothalamus and it performs various functions, including influencing the normal functioning of the urinary system.

Diabetes insipidus is not a hereditary disease, but some autosomal recessive inherited syndromes (for example, Wolfram's disease, complete or incomplete diabetes insipidus) are part of the clinical picture, indicating a genetic mutation.

Factors predisposing to the development of this pathology are:

• diseases of an infectious nature, especially viral ones;
• brain tumors (meningioma, craniopharyngioma);
• metastases to the hypothalamus of cancer of extracerebral localization (usually bronchogenic - originating from bronchial tissue, and breast cancer);
• skull injuries;
• concussions;
• genetic predisposition.

In the idiopathic form of diabetes insipidus, the patient’s body, for no apparent reason, begins to produce antibodies that destroy the cells that produce antidiuretic hormone.

Renal diabetes insipidus (renal form) occurs as a result of intoxication of the body with chemicals, disorders or previous diseases of the kidneys and urinary system (renal failure, hypercalcinosis, amyloidosis, glomerulonephritis).

Diabetes

There are two reasons why women's blood sugar levels are higher than normal. Insulin-dependent diabetes occurs as a result of a failure of the endocrine system when the pancreas does not fully provide the woman's body with the insulin necessary to break down sugar in the blood. More recently, the main age category for type 1 diabetes was people under 30 years of age. Recent studies have revealed a trend of increasing the age threshold to 40 years.

The risk of developing an autoimmune disease increases as a result of:

• Past illnesses associated with viral infection.
• Consequences of cancer problems.
• Stressful state over a long period.
• Failure of the immune system, in which the antibodies produced have a destructive effect on the cellular structure of the pancreas.

Type 2 diabetes is characterized as non-insulin dependent. Its essence lies in the immunity of the body's cells to the insulin produced. One of the leading culprits of a serious diagnosis is a woman’s excess weight and lack of physical activity. Characteristic problems often develop after 30 years.

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The hereditary factor plays a significant role in type 2 diabetes mellitus. In some cases, diabetes mellitus is transmitted from a pregnant woman to her newborn. Insulin-dependent diabetes, type 1, is inherited in a ratio of 1:10. Treatment is more complex, so timely diagnosis is extremely important.

Symptoms of diabetes insipidus in adults

The disease occurs equally in men and women, at any age, most often between the ages of 20-40 years. The severity of the symptoms of this disease depends on the degree of vasopressin deficiency. With a slight deficiency of the hormone, clinical symptoms may be blurred and not clearly expressed. Sometimes the first symptoms of diabetes insipidus appear in people who have been in conditions of drinking deficiency - during travel, hiking, expeditions, and also when taking corticosteroids.

The main symptoms of diabetes insipidus include the following:

• excessive urination (up to 3–15 liters of urine per day);
• the main volume of urination occurs at night;
• thirst and increased fluid intake;
• dry skin, nausea and vomiting, convulsions;
• mental disorders (insomnia, emotional lability, decreased mental activity).

Even if the patient is limited in fluid intake, urine will still be released in large quantities, which will lead to general dehydration of the body.

In addition to general symptoms, there are a number of individual symptoms that occur in patients of different genders and ages:

Changes in the body with high sugar

First, you need to determine what is considered normal for women, and what information about blood sugar is considered abnormal.

People who regularly take blood sugar tests for preventive purposes are extremely rare. You will get a chance to stop the disease in the early stages as a result of qualified treatment, promptly paying attention to the main symptoms of diabetes in women:

• a sharp change in body weight towards increase or decrease;
• feeling thirsty on a constant basis;
• smell of acetone from the mouth;
• increased appetite, constant desire for sweets;
• frequent increase in blood pressure;
• the condition of the hair and nail plates is unsatisfactory;
• the skin of the face and hands changes pigmentation;
• increased weakness, often accompanied by dizziness, chronic fatigue;
• weakened immunity, accompanied by frequent viral infections;
• itching of the skin due to dryness;
• frequent headaches;
• low body temperature;
• irritability, nervousness;
• cramps and pain in the leg muscles, pain in the heart;
• slow wound healing process.

Women over 30 also experience an almost complete lack of desire for sexual activity. This occurs due to hormonal imbalance and poor body condition. After 50 years, there is a possibility of decreased vision and blurred vision. Do not panic if you discover one or more manifestations of the disease. A timely visit to a medical facility will help dispel any doubts that may arise. If blood sugar levels are higher than normal, an appropriate course of treatment should be started. In addition to the main changes, there are signs of diabetes mellitus in women, manifested in the gynecological area:

Clinical picture

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• menstrual irregularities;
• the presence of microcracks in the mucous membrane, the appearance of dry skin;
• through microcracks, the penetration of viral infections, fungi and the development of inflammatory processes is possible;
• The acid-base balance in the vagina changes.

Often, women over 50 attribute problems that arise to the menopause. However, you should not be careless; this applies not only to older women, but also to pregnant women. The main goal of establishing the correct diagnosis and type of diabetes is to provide appropriate treatment. The most accessible research method is an analysis that detects blood sugar levels. Another argument that speaks of the invaluable benefits of a blood test is diabetes in a latent form. Untimely treatment in such situations leads to the development of complications.

Complications

The danger of diabetes insipidus lies in the risk of developing dehydration of the body, which occurs in situations in which the loss of fluid from the body through urine is not adequately replenished. Characteristic manifestations of dehydration are:

• general weakness and tachycardia,
• vomit,
• mental disorders.

Blood thickening, neurological disorders and hypotension, which can reach a state of collapse, are also noted. It is noteworthy that even severe dehydration is accompanied by persistence of polyuria.

Complications in women and men

If the patient does not have time to completely replenish fluid loss or tries to reduce urine output in this way, then signs of dehydration quickly increase:

• nausea, vomiting;
• blood thickening, tendency to thrombosis;
• headache, dizziness;
• pressure drop down to a collapsed state;
• severe weakness;
• rapid and weak pulse;
• loss of body weight.

Mental and neurological disorders, decreased potency in men, and disruption of the menstrual cycle in women are also possible. A large volume of fluid entering and leaving the body leads to overdistension of the stomach, prolapse, irritation of the intestines, disruption of the secretion of bile and digestive enzymes. The bladder, ureters and renal pelvis expand.

In the central form of diabetes insipidus, there is often insufficient excretion of other hormones - panhypopituitarism.

Diagnostics

A doctor who deals with such pathologies is an endocrinologist. If you feel most of the symptoms of this disease, then the first thing you should do is go to an endocrinologist.

At your first visit, the doctor will conduct an “interview”. It will allow you to find out how much water a woman drinks per day, whether she has problems with the menstrual cycle, urination, whether she has endocrine pathologies, tumors, etc.

In typical cases, the diagnosis of diabetes insipidus is not difficult and is based on:

• pronounced thirst
• daily urine volume is more than 3 liters per day
• plasma hyperosmolality (more than 290 mOsm/kg, depends on fluid intake)
• high sodium content
• hypoosmolality of urine (100–200 mOsm/kg)
• low relative density of urine (<1010).

Laboratory diagnosis of diabetes insipidus includes the following:

• conducting a Zimnitsky test - accurate calculation of daily fluid consumed and excreted;
• ultrasound examination of the kidneys;
• X-ray examination of the skull;
• computed tomography of the brain;
• echoencephalography;
• excretory urography;
• detailed biochemical blood test: determination of the amount of sodium, potassium, creatinine, urea, glucose ions.

The diagnosis of diabetes insipidus is confirmed based on laboratory data:

• low urine osmolarity;
• high level of blood plasma osmolarity;
• low relative density of urine;
• high sodium levels in the blood.

Causes and mechanism of development

According to ICD 10, two types of ND are classified in different chapters.

ADH is produced by the hypothalamus and serves to organize reabsorption in the nephrons of the kidneys.

If reabsorption is impaired, large quantities of unfiltered urine are released from the body, and thirst appears due to significant loss of moisture.

Pathophysiology distinguishes two mechanisms for the development of diabetes insipidus in accordance with the location of the problem area in the body:

1. The neurogenic form is characterized by insufficient production of ADH.
2. Renal DI occurs due to the inability of the kidney nephrons to take up and use incoming vasopressin to filter fluid.

The pathogenesis of the two main types of ND differs, but the causes are largely similar. The development of pathology is caused by genetic predisposition, as well as diseases and injuries of the head or urinary organs.

Nephrogenic diabetes can be caused by:

• kidney diseases;
• poisoning with drugs and toxic substances;
• pathology of the kidney tubules.

Causes of the neurogenic form:

• brain surgery;
• malignant neoplasms and metastases;
• infectious, inflammatory and vascular diseases of the brain.

Important: In almost a third of cases, it is not possible to find out the causes of the pathology.

Treatment

After confirming the diagnosis and determining the type of diabetes insipidus, therapy is prescribed aimed at eliminating the cause that caused it - tumors are removed, the underlying disease is treated, and the consequences of brain injuries are eliminated.

To compensate for the required amount of antidiuretic hormone for all types of disease, desmopressin (a synthetic analogue of the hormone) is prescribed. It is applied by instillation into the nasal cavity.

Desmopressin drugs are now widely used to compensate for central diabetes insipidus. It is produced in 2 forms: drops for intranasal administration - Adiuretin and tablet form Minirin.

Clinical recommendations also include the use of drugs such as Carbamazepine and Chlorpropamide to stimulate the body’s production of the hormone. Since excessive urine production leads to dehydration of the body, saline solutions are administered to the patient to restore the water-salt balance.

When treating diabetes insipidus, drugs that affect the nervous system (for example, Valerian, Bromine) can also be prescribed. Nephrogenic diabetes requires the prescription of anti-inflammatory drugs and thiazide diuretics.

An important component of the treatment of diabetes insipidus is the correction of water-salt balance using infusion of a large volume of saline solutions. To effectively reduce diuresis, it is recommended to take sulfonamide diuretics.

Thus, diabetes insipidus is the result of a deficiency of antidiuretic hormone in the human body for various reasons. However, modern medicine makes it possible to compensate for this deficiency with the help of replacement therapy with a synthetic analogue of the hormone.

Competent therapy returns a sick person to the mainstream of a full life. This cannot be called a complete recovery in the literal sense of the word, however, in this case, the state of health is as close as possible to normal.

Symptoms

In most cases, diabetes insipidus develops acutely. The main manifestations of the disease are the release of large amounts of urine (more than 3 liters per day) and severe thirst. In this case, excess urine is the primary symptom, and thirst is secondary. Sometimes the amount of urine per day can be 15 liters.

Urine in diabetes insipidus has its own characteristics:

• low relative density (specific gravity) - less than 1005 (always, in any portion of urine, regardless of the amount of liquid drunk);
• has no color, does not contain enough salts (compared to normal urine);
• free from pathological impurities (for example, increased levels of leukocytes, the presence of red blood cells).

A characteristic feature of diabetes insipidus is the passage of urine at any time of the day, including at night. The constant urge to urinate makes it impossible to fall asleep and exhausts the patient. Sooner or later, this situation leads to nervous exhaustion of the body. Neuroses and depression develop.

Even if a person is not allowed to drink, a lot of urine will still be produced, leading to dehydration. A diagnostic test is based on this phenomenon to confirm the presence of diabetes insipidus in a patient. This is the so-called dry food test. For 8-12 hours the patient is not given any liquid (including with food). Moreover, in the case of existing diabetes insipidus, urine continues to be excreted in large quantities, its density does not increase, osmolarity remains low, and weight is lost by more than 5% of the original.

The intake of excess urine leads to expansion of the renal pelvis system, ureters and even the bladder. Of course, this does not happen immediately, but over a certain period of illness.

Thirst in diabetes insipidus is a consequence of the loss of huge amounts of fluid in the urine. The body tries to find ways to restore the contents of the bloodstream, and therefore thirst arises. I want to drink almost constantly. A person drinks water in liters. Due to such water overload of the gastrointestinal tract, the stomach is stretched, the intestines are irritated, digestive problems and constipation arise. At first, with diabetes insipidus, the fluid supplied through drinking compensates for losses in the urine, and the cardiovascular system does not suffer. However, over time, fluid deficiency still occurs, blood flow becomes insufficient, and the blood thickens. Then symptoms of dehydration occur. Severe general weakness, dizziness, headache appear, heart rate increases, blood pressure drops, and collapse may develop.

Signs of a chronic lack of fluid in the body with long-term diabetes insipidus include dry and flabby skin, an almost complete absence of sweat, and a small amount of saliva. Weight is invariably lost. I am concerned about the feeling of nausea and periodic vomiting.

In women, the menstrual cycle is disrupted, in men, potency is weakened. Of course, all these changes occur in the absence of adequate treatment for diabetes insipidus.

Nutrition and diet for diabetes insipidus

The main goal of diet therapy is to reduce urination, and in addition, to replenish the body with vitamins and minerals that they “lose” due to frequent urge to go to the toilet.

It is worth giving preference to cooking in these particular ways:

• boil;
• steamed;
• stew food in a saucepan with olive oil and water;
• bake in the oven, preferably in a sleeve, to preserve all the beneficial substances;
• in a slow cooker, except for the “fry” mode.

When a person has diabetes insipidus, the diet should exclude those categories of foods that increase thirst, for example, sweets, fried foods, spices and seasonings, and alcohol.

The diet is based on the following principles:

• reduce the amount of protein consumed, leaving the norm of carbohydrates and fats;
• reduce salt concentration by reducing its consumption to 5 g per day;
• food should consist mainly of vegetables and fruits;
• to quench your thirst, use natural juices, fruit drinks and compotes;
• eat only lean meat;
• include fish and seafood, egg yolks in the diet;
• take fish oil and phosphorus;
• eat small meals often.

Sample menu for the day:

• first breakfast – omelet (steamed) of 1.5 eggs, vinaigrette (with vegetable oil), tea with lemon;
• second breakfast – baked apples, jelly;
• lunch - vegetable soup, boiled meat, stewed beets, lemon drink;
• afternoon snack – rosehip decoction, jam;
• dinner - boiled fish, boiled potatoes, sour cream, tea with lemon.

Drinking plenty of fluids is necessary - after all, the body loses a lot of water during dehydration and needs to be compensated.

Nutrition for diabetes insipidus

In the treatment of diabetes insipidus, proper nutrition is required.

The diet for this disease involves:

• decreased amount of urine;
• quenching thirst;
• replenishment of nutrients that are lost during bowel movements.

The diet is as follows:

1. Reduce salt intake. Only 5 - 6 grams are allowed. per day. In order to control the process of salt entering the body, it is recommended to cook food without adding it, but to eat it by adding it to food yourself in the amount that is allowed.
2. Include dried fruits in the menu. They contain large amounts of potassium, which promote the production of vasopressin.
3. Avoid sweets. Sweet dishes and foods increase thirst, as do alcohol and sugary carbonated drinks, so they definitely need to be removed from the diet.
4. Fresh vegetables, fruits, berries, they contain many useful vitamins and substances.
5. Milk and fermented milk products are allowed.
6. Freshly squeezed juices, compotes (preferably homemade), and fruit drinks will also be useful to include in your menu.
7. Lean fish, seafood, lean meats.
8. Egg yolk. It is not recommended to consume proteins because they increase the load on the kidneys.
9. Fats (oil in any form), carbohydrates (pasta, bread, potatoes) must be included in the daily diet.

Folk remedies

Before using folk remedies for diabetes insipidus, be sure to consult an endocrinologist, because possible contraindications.

1. Twenty grams of dried elderberry inflorescences are poured into a glass of very hot water, and the resulting decoction is infused for one hour. The resulting composition is mixed with a spoon of honey and consumed three times daily.
2. To significantly get rid of thirst and reduce urine output, it is necessary to be treated with burdock infusion. To prepare the product, you will need 60 grams of the root of this plant, which must be crushed as much as possible, poured into a liter thermos and filled with boiling water until the volume is full. You need to infuse burdock root until the morning, after which the remedy is taken 3 times a day, half a glass.
3. Motherwort infusion for diabetes insipidus. Ingredients: motherwort (1 part), valerian root (1 part), hop cones (1 part), rose hips and mint (1 part), boiling water (250 ml.). All herbal ingredients are mixed and thoroughly crushed. Take 1 spoon of the mixture and pour boiling water over it. They insist for an hour. Take in an amount of 70 - 80 ml. before bedtime. Benefits: the infusion calms the body, relieves irritability, and improves sleep.
4. To reduce thirst and restore balance in the body, you can use infused walnut leaves. The young leaves of this plant are collected, dried and crushed. After this, a teaspoon of the dry substance is brewed with a glass (250 milliliters) of boiling water. After just fifteen minutes, the resulting decoction can be consumed like regular tea.
5. A collection of different herbs will also help to overcome the disease: fennel motherwort, valerian, fennel, caraway seeds. All ingredients must be taken in equal quantities and mixed well. After this, a tablespoon of the dry mixture is poured into a glass of boiling water and left until the liquid cools completely. You need to take half a glass before bed.

Criteria for diagnosis

The first signs of ND are obvious - excessive thirst and frequent urination even at night.

A complete diagnosis of the disease includes:

• Zimnitsky test;
• determination of daily urine volume;
• blood and urine osmolarity test;
• determination of urine density;
• determination of glucose, sodium, urea, potassium in the blood;
• CT, radiography, echoencephalography of the brain;
• radiography, ultrasound of the kidneys.

Table of signs of ND based on analysis results:

To exclude diabetes mellitus, a blood glucose test is performed on an empty stomach.

If blood and urine osmolarity are normal, a fluid exclusion test is performed.

Based on changes in body weight, the amount of sodium in the blood serum and osmolarity, renal and neurogenic types of diabetes are differentiated. This is necessary as the treatment will vary.

Treatment of ND

If it is possible to find out the cause of diabetes, they fight the disease that provokes diabetes. Further treatment is carried out depending on the type of disease.

Neurogenic type

Treatment with drugs is carried out when urine output exceeds 4 liters per day.
If the volume is less, patients are prescribed a diet that includes monitoring fluid intake. Clinical recommendations prescribe the use of Minirin, which is a substitute for ADH. The dose of the drug is selected individually and does not depend on age and weight. The criterion is an improvement in condition, a decrease in urination and thirst. Take the product 3 times a day.

The drugs Carbamazepine and Chlorpropamide improve the synthesis of vasopressin. Adiurecrin is instilled into the nose to reduce dry mucous membranes and reduce urine output.

Renal type

To treat nephrogenic type diseases, diuretics are used - Hypothiazide, Indapamide, Triampur. To replenish potassium loss, Asparkam or Panangin are prescribed.

Sometimes treatment is supplemented with anti-inflammatory drugs. The choice of means depends on the severity of the condition and the degree of damage to the urinary tubules.

In the treatment of both types of disease, sedatives are used to help alleviate the general condition, improve sleep, and calm the nervous system.

Diet

The diet is aimed at reducing thirst and replenishing nutrients lost in urine. Patients are advised to reduce salt and sugar intake to a minimum.

It is recommended to eat 5-6 times a day.

Healthy foods:

• dried fruits – replenish potassium losses;
• seafood – high phosphorus content;
• fresh vegetables and fruits;
• low-fat meat.

Necessary fats and carbohydrates are both types of oil, potatoes, pasta.

This corresponds to diets No. 7 and 10.

Diabetes insipidus: diagnosis

Before you find out what measures are being taken to treat diabetes insipidus, you need to understand how the disease is diagnosed.

When a patient approaches a doctor with characteristic complaints, the doctor clarifies certain points. Firstly, how much urine is released per day. If more than 3 liters, then this symptom indicates that the patient has diabetes insipidus.

Secondly, it is clarified whether there is bedwetting, whether the patient drinks water at night, how many times he visits the toilet, and how he sleeps.

Upon completion of the survey, if the doctor suspects the development of disease insipidus, the following diagnostic measures are recommended:

1. Determination of the relative density of urine.
2. Determination of osmolarity of urine and blood.
3. X-ray of the skull and sella turcica.
4. Ultrasound examination of the kidneys.
5. Determination of the level of mineral components in the body.
6. Zimnitsky's test.

Based on tests obtained in laboratory conditions, the criteria for detecting diabetes mellitus are the following:

• If sodium in the blood rises to more than 155 units.
• Blood osmolarity is more than 290 units.
• Reducing urine osmolarity to 100-200 units.
• Low urine density.

If laboratory tests show that the osmolarity of biological fluids is within the acceptable range, but the patient still has symptoms of sugar insipidus, then a fluid restriction test is recommended.

The essence of this analysis is that if a small amount of fluid enters the patient’s body, after 5-8 hours the production of vasopressin is stimulated.

A remarkable fact is that this test allows not only to diagnose the disease, but also to identify its form.

Prevention

To prevent the development of diabetes insipidus, it is necessary to treat infectious diseases in a timely manner. Since the cause of the disease is often associated with infections. During neurosurgical interventions, it is necessary to strictly follow the doctor’s recommendations.

But medical errors can often occur. Which in this case leads to serious consequences. Kidney pathology develops. Malignant tumor diseases can be prevented as follows:

• clinical examination;
• laboratory research

This is necessary to directly prevent this disease. Annual medical examinations can help prevent the development of diabetes insipidus. And laboratory diagnostics allows us to identify early pathological changes.

Also, in preventing the disease, you should protect yourself from exposure to chemical compounds. After all, it is lithium that can serve as a prerequisite for the development of the disease. To prevent renal failure, it is necessary to cure various pathologies in a timely manner.

It is very necessary to calculate daily diuresis. If you find that there is a discrepancy between the fluid you drink and the fluid you excrete, you should consult a doctor. Which is an important preventative measure.

Non-sugar diabetes is a hormonal pathology, so the level of hormones in the body should be monitored. It is very important to seek advice from an endocrinologist. This will reduce the risk of developing the disease.

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Symptoms

When diabetes insipidus develops, symptoms are immediately noticeable in both men and women.

Increased urination

The first and main sign is that the volume of daily urine excreted reaches 3-5 liters. After a while, the amount of urine increases to 15 liters.

Because The urge to urinate also occurs at night, this leads to disruption of proper sleep, loss of strength and severe fatigue are noted. Over time, this condition provokes nervous exhaustion, depression, and neuroses.

With a reduction in fluid intake, urine output and urination frequency will not change. Which will lead to complete dehydration of the body.

Urine excreted in diabetes insipidus:

• has a low specific gravity, which can be detected during analysis;
• characterized by the absence of a standard amount of salts, which can also be identified after analyzing the submitted material;
• colorless or slightly yellow;
• does not have standard impurities, for example, increased levels of red blood cells or white blood cells.

Diabetes insipidus, symptoms in children (infants and 1 year olds) provoke more pronounced symptoms, they may have:

• vomit;
• the temperature is rising;
• Neurological disorders occur in the body.

In older children, enuresis may occur, i.e. urinary incontinence.

Extreme thirst

In the presence of pathology, a persistent feeling of thirst is formed; a person is able to consume a lot of liquid per day. This is due to the fact that the body needs to restore water balance. Due to such deviations, many systems and organs “suffer”.

Associated symptoms include:

• an increase in the volume of the bladder, renal pelvis system and ureters;
• the presence of irritation in the intestinal mucosa;
• changes in the size of the stomach (its stretching, prolapse), which is caused by the daily replenishment of large amounts of fluid;
• critically low level of sweating;
• dry mouth, because saliva production is significantly reduced;
• disruptions in the menstrual cycle, impaired potency in men;
• problems in the gastrointestinal tract.

Even if you regularly replenish your body's fluid supply, dehydration cannot be prevented; it manifests itself in the following:

• weakening of blood flow;
• increased blood viscosity;
• increased heart rate;
• decrease and “jumps” in blood pressure;
• collapse.

The person’s condition worsens, which is associated with the presence of a severe headache; increased dryness and sagging skin; weight loss. Over time, deviations in the functioning of the gastrointestinal tract appear.

All the described symptoms are observed in the presence of an advanced stage of the disease. To prevent this from happening, it is important to diagnose diabetes insipidus in time and carry out the necessary treatment.

Forecast

Modern medicine cannot cure the disease. The prescribed medications help maintain fluid balance and alleviate the condition. In case of compensation, the patient remains able to work.

Prevention of diabetes insipidus is based on timely treatment of diseases and injuries that can trigger the development of diabetes. This applies to both problems with the brain and kidney pathologies.

Video material about diabetes insipidus, its causes and treatment:

Patients with ND need to strictly monitor the intake of medications and follow a diet and drinking regime. This will help improve your quality of life and avoid additional problems with the cardiovascular and nervous systems.

Degrees and stages of diabetes insipidus

Based on the general clinical picture, the disease has its own classification according to severity:

• mild degree . Diabetes insipidus is characterized by a daily urine output of 5-7 liters;
• the average degree is characterized by 8-13 liters of urine excreted per day;
• severe degree . The daily amount of urine is more than 13 liters.

When diabetes insipidus is corrected with medications, its course is divided into three stages:

1. Compensation stage. At this stage there are no symptoms of unquenchable thirst. There is no increase in the volume of urine excreted;
2. Subcompensatory stage. Signs of polyuria and periodic feelings of thirst appear;
3. Stage of decompensation. There is a constant feeling of thirst and severe symptoms of polyuria, regardless of treatment.

Central diabetes insipidus - modern ideas about diagnosis and treatment

Synthesis and secretion of antidiuretic hormone

The antidiuretic hormone vasopressin is synthesized in the supraoptic and paraventricular nuclei of the hypothalamus.
By binding to the carrier protein neurophysin, the ADH-neurophysin complex in the form of granules is transported to the terminal extensions of the neurohypophysis and median eminence axons. ADH accumulation occurs in axon endings in contact with capillaries. ADH secretion depends on plasma osmolality, circulating blood volume, and blood pressure levels. Osmotically sensitive cells located in the periventricular regions of the anterior hypothalamus respond to changes in the electrolyte composition of the blood. Increased activity of osmoreceptors with an increase in blood osmolality stimulates vasopressinergic neurons, from the endings of which vasopressin is released into the general bloodstream. Under physiological conditions, plasma osmolality is in the range of 282–300 mOsm/kg [5]. Normally, the threshold for ADH secretion is the osmolality of blood plasma starting from 280 mOsm/kg. Lower values ​​for ADH secretion can be observed during pregnancy, acute psychosis, and cancer. A decrease in plasma osmolality caused by large amounts of fluid intake suppresses ADH secretion. At a plasma osmolality level of more than 295 mOsm/kg, an increase in ADH secretion and activation of the thirst center are observed (Fig. 1). The activated thirst center and ADH, controlled by the osmoreceptors of the choroid plexus of the anterior part of the hypothalamus, prevents dehydration of the body [18]. Regulation of vasopressin secretion also depends on changes in blood volume. During bleeding, volume receptors located in the left atrium have a significant effect on the secretion of vasopressin. In blood vessels, blood pressure acts through V1-baroosmoreceptors, which are located on the smooth muscle cells of blood vessels. The vasoconstrictor effect of vasopressin during blood loss is due to contraction of the smooth muscle layer of the vessel, which prevents a drop in blood pressure. When blood pressure decreases by more than 40%, an increase in the level of ADH is observed, 100 times higher than its basal concentration [1, 3]. Baroreceptors located in the carotid sinus and aortic arch respond to increased blood pressure, which ultimately leads to a decrease in ADH secretion. In addition, ADH is involved in the regulation of hemostasis, the synthesis of prostaglandins, and promotes the release of renin [6].

Sodium ions and mannitol are powerful stimulators of vasopressin secretion. Urea does not affect the secretion of the hormone, but glucose leads to inhibition of its secretion [3].

Mechanism of action of antidiuretic hormone

ADH is the most important regulator of water retention and promotes fluid homeostasis in conjunction with atrial natriuretic hormone, aldosterone and angiotensin II.

The main physiological effect of vasopressin is to stimulate the reabsorption of water in the collecting ducts of the renal cortex and medulla against the osmotic pressure gradient [6].

In renal tubular cells, ADH acts through V2 baroreceptors (type 2 vasopressin receptors), which are located on the basolateral membranes of collecting tubule cells. The interaction of ADH with V2 receptors leads to activation of vasopressin-sensitive adenylate cyclase and increased production of cyclic adenosine monophosphate (AMP). Cyclic AMP activates protein kinase A, which in turn stimulates the incorporation of water channel proteins, aquaporin-2, into the apical cell membrane. This ensures the transport of water from the lumen of the collecting ducts into the cell and further: through the water channel proteins aquaporin-3 and aquaporin-4 located on the basolateral membrane, water is transported into the intercellular space and then into the blood vessels. The result is concentrated urine with high osmolality (Fig. 2).

Osmotic concentration is the total concentration of all dissolved particles. It can be interpreted as osmolarity and measured in osmol/l or as osmolality - in osmol/kg. The difference between osmolarity and osmolality lies in the method of obtaining this value. For osmolarity, this is a calculation method based on the concentration of the main electrolytes in the measured liquid. Formula for calculating osmolarity:

Osmolarity = 2 x {Na (mmol/L) + K (mmol/L)} + glucose (mmol/L) + urea (mmol/L) + 0.03 x total protein (g/L) [5].

Osmolality of plasma, urine and other biological fluids is the osmotic pressure depending on the amount of ions, glucose and urea, which is determined using an osmometer device. Osmolality is less than osmolarity by the amount of oncotic pressure.

With normal ADH secretion, urine osmolarity is always above 300 mOsm/L and can even increase to 1200 mOsm/L and higher. With ADH deficiency, urine osmolarity is below 200 mOsm/L [4, 5].

Etiological factors of central diabetes insipidus

Among the primary causes of the development of CND, there is a hereditary familial form of the disease, transmitted by an autosomal dominant or autosomal recessive type of inheritance. The presence of the disease can be traced in several generations and can affect a number of family members; it is caused by mutations leading to changes in the structure of ADH (DIDMOAD syndrome). Congenital anatomical defects in the development of the midbrain and diencephalon may also be the primary causes of the development of CND. In 50–60% of cases, the primary cause of CDI cannot be determined—this is the so-called idiopathic diabetes insipidus [17].

Among the secondary causes leading to the development of CND are traumatic brain injury (concussion, orbital injury, fracture of the base of the skull).

The development of secondary NSD may be associated with conditions after transcranial or transsphenoidal surgery on the pituitary gland for brain tumors such as craniopharyngioma, pinealoma, germinoma, leading to compression and atrophy of the posterior pituitary gland [12].

Inflammatory changes in the hypothalamus, supraopticohypophyseal tract, infundibulum, stalk, and posterior lobe of the pituitary gland are also secondary causes of the development of CND.

The leading factor in the occurrence of the organic form of the disease is infection. Acute infectious diseases include influenza, encephalitis, meningitis, tonsillitis, scarlet fever, whooping cough; among chronic infectious diseases are tuberculosis, brucellosis, syphilis, malaria, rheumatism [9, 10].

Among the vascular causes of CDI can be called Sheehan's syndrome, disorders of the blood supply to the neurohypophysis, thrombosis, and aneurysms.

Depending on the anatomical location, CDI can be permanent or transient. If the supraoptic and paraventricular nuclei are damaged, the ADH function is not restored.

The development of nephrogenic ND is based on congenital receptor or enzymatic disorders of the distal tubules of the kidneys, leading to receptor resistance to the action of ADH. In this case, the content of endogenous ADH may be normal or increased, and taking ADH does not eliminate the symptoms of the disease. Nephrogenic ND can occur with long-term chronic urinary tract infections, urolithiasis (UCD), and prostate adenoma.

Symptomatic nephrogenic DI can develop in diseases accompanied by damage to the distal tubules of the kidneys, such as sickle cell anemia, sarcoidosis, amyloidosis. Under conditions of hypercalcemia, sensitivity to ADH decreases and water reabsorption decreases.

Psychogenic polydipsia develops on a nervous basis, mainly in women of menopausal age (Table 1). The primary occurrence of thirst is caused by functional disorders in the thirst center [14]. Under the influence of a large amount of fluid and an increase in the volume of circulating plasma, a decrease in ADH secretion occurs through the baroreceptor mechanism. Urine examination according to Zimnitsky in these patients reveals a decrease in relative density, while the sodium concentration and osmolarity of the blood remain normal or reduced. When limiting fluid intake, patients' health remains satisfactory, while the amount of urine decreases, and its osmolarity increases to physiological limits [11].

Clinical picture of central diabetes insipidus

For the manifestation of ND, a decrease in the secretory capacity of the neurohypophysis by 85% is necessary [2, 8].

The main symptoms of ND are excessive frequent urination and extreme thirst. Often the volume of urine exceeds 5 liters, and can even reach 8–10 liters per day.

Hyperosmolarity of blood plasma stimulates the thirst center. The patient cannot go without drinking fluid for more than 30 minutes. The amount of fluid drunk in a mild form of the disease usually reaches 3-5 liters, in a moderate form - 5-8 liters, in a severe form - 10 liters or more. Urine is discolored, its relative density is 1000–1003 g/l. In conditions of excessive fluid intake, patients' appetite decreases, the stomach becomes overdistended, gastrointestinal secretion decreases, gastrointestinal motility slows down, and constipation develops. When the hypothalamic region is damaged by an inflammatory or traumatic process, along with ND, other disorders may be observed, such as obesity, growth pathology, galactorrhea, hypothyroidism, and diabetes mellitus (DM) [3, 5]. As the disease progresses, dehydration leads to dry skin and mucous membranes, decreased salivation and sweating, and the development of stomatitis and nasopharyngitis. With severe dehydration, general weakness and palpitations begin to increase, a decrease in blood pressure is noted, the headache quickly intensifies, and nausea appears. Patients become irritable, there may be hallucinations, convulsions, and collapsed states.

Diagnosis of central diabetes insipidus

To confirm the diagnosis, at the first stage of the examination, the most common causes of nephrogenic DI (diabetes mellitus, hypercalcemia, hypokalemia, inflammatory kidney diseases) must be excluded. If plasma hyperosmolarity (more than 3000 mOsm/kg), hypernatremia and urine hypoosmolarity (100–200 mOsm/kg) are detected, they proceed to the second stage of the examination [5].

At this stage of the examination, a dehydration test (dry food test) is performed to exclude primary polydipsia and a test with desmopressin to exclude nephrogenic ND.

The classic test with dry eating consists of prohibiting the consumption of any liquid for 6–14 hours. Before and during the test (every 1–2 hours), body weight, blood pressure, pulse are measured, blood plasma osmolality, sodium content in blood plasma, volume and urine osmolality. The dry food test is stopped when the patient loses more than 5% of body weight, unbearable thirst, an increase in sodium content and an increase in blood osmolality above normal limits. If during the test the blood osmolality is >300 mOsm/kg, the sodium level is >145 mmol/l, and the urine osmolality is <300 mOsm/kg, a desmopressin test is performed for further differential diagnosis of central and nephrogenic DI. To do this, the patient takes 10 mcg or 0.1 mg of desmopressin or subcutaneously, IM or IV, an equivalent dose of 2 mcg of desmopressin is administered. The patient is allowed to drink liquid not exceeding 1.5 times the volume of urine excreted during the dry-eating test. After 2 and 4 hours, urine is collected to determine volume and osmolality.

If, after the administration of desmopressin, the level of urine osmolality increases by more than 50%, the central form of ND is diagnosed. If the effect of the administered drug is less than 50% or absent, this indicates a nephrogenic form of ND.

Difficulties in diagnosis are presented by partial forms of CDI, nephrogenic DI, primary polydipsia, since in these cases there is no clear clinical picture. After a dry diet test, urine osmolality in these patients is determined in the range from 300 to 750 mOsm/kg; after taking desmopressin, urine osmolality is <750 mOsm/kg. Further examination of patients while taking low doses of desmopressin (10 mcg x 1–2 times/day, 0.1 mg x 1–2 times/day) for 7 days includes determination of daily diuresis, osmolality of blood and urine. In patients with primary polydipsia, while taking desmopressin medications, general health does not improve.

Patients with a confirmed diagnosis of CND undergo magnetic resonance imaging of the brain to determine the cause of the disease and identify pathological changes in the hypothalamic-pituitary region [5].

Treatment

Replacement therapy for CND is carried out with a synthetic analogue of ADH - desmopressin. Features of the chemical structure of desmopressin include the substitution of L-arginine in the 8th position of the chain with D-arginine, as well as additional deamination of cysteine ​​in the 1st position. The drug acts only on the V2 receptors of the renal tubules and does not act on the V1 receptors of the smooth muscles of the blood vessels. In this regard, when taking the drug, minimal vasoconstrictor activity and a more pronounced and prolonged antidiuretic effect are observed [16].

Among the dosage forms of desmopressin there are: oral tablet form, sublingual tablet form and intranasal spray (Table 2). For CND, the average therapeutic doses of tableted desmopressin vary from 0.1 mg to 1.6 mg/day, the frequency of administration is 2–3 times/day. When using the tablet sublingual form, the initial dose of the drug is 60 mcg 2–3 times/day, the average daily dose is from 60 to 360 mg/day. When administering the drug intranasally, the daily dose is from 10 mcg to 40 mcg/day, which is due to individual sensitivity to the drug; the frequency of administration is 2 times a day [7, 13].

When taking the tablet form, the antidiuretic effect is observed after 1–2 hours. Intranasal administration provides a faster onset of action after 15–30 minutes, since the administration of the drug is not associated with food intake, which ensures greater bioavailability [15]. Also, a rapid therapeutic effect is observed when using the sublingual form of the drug, the onset of action is 15–45 minutes after administration. The interval between taking the drug and eating is 5–10 minutes.

It must be taken into account that food intake reduces the absorption of the drug and its effectiveness, therefore it is recommended to take the tablet form of the drug on an empty stomach 30–40 minutes before a meal or 2 hours after it. The intranasal spray can be used regardless of food intake in patients with various gastrointestinal diseases and in patients in intensive care units. At the same time, catarrhal symptoms in patients significantly complicate treatment with this form of desmopressin. The sublingual form of administration of the drug is practically not associated with food intake and is easily titrated. This form of desmopressin allows you to more accurately select the required dose of the drug.

When replacing or switching from one form of desmopressin to another, the dose taken is recalculated (Table 3).

Conclusion

Currently, various forms of desmopressin are used to effectively treat patients with CND. Only individual selection of the drug and titration of its dose make it possible to achieve clinical and laboratory compensation for the disease.

Literature

1. John F. Laycock, Peter G. Weiss. Fundamentals of endocrinology. M.: Medicine, 2000.
2. Dzeranova L.K., Pigarova E.A. Minirin in the treatment of diabetes insipidus // Breast Cancer. 2005.
3. T. 13. No. 28. P. 1961–1965.
4. Kochergina I. I. Diabetes insipidus: selected lectures on endocrinology / Ed. ed. A. A. Ametova. M.: Medical Information Agency, 2009. pp. 217–254.
5. Melnichenko G.A., Peterkova V.A., Fofanova O.V. Diagnosis and treatment of diabetes insipidus: method. recommendations. M., 2003.
6. Pigarova E.A., Dzeranova L.K., Rozhinskaya L.Ya. Central diabetes insipidus: differential diagnosis and treatment: method. recommendations. M., 2010.
7. Ball SG Vasopressin and disoders of water balance: the physiology and pathophysiology // Ann. Clin. Biochem. 2007. Vol. 44. P. 417–431.
8. Goldman MB et al. The influence of polydipsia on water excretion in hyponatremic, polydipsic, schizophrenic patients // J. Clin. Endocrinol. Metabol. 1996. Vol. 81(4). P. 1465–1470.
9. Goodfriend TL, Friedman AL, Shenker Y. Chapter 133. Hormonal regulation of electrolyte and water metabolism. Endocrinology, 5th Edition / Ed. by De Groot LJ, Jameson JL Philadelphia: Saunders, 2006. Vol. 2. P. 1324–1367.
10. Laczi F. Diabetes insipidus: etiology, diagnosis and therapy // Orv. Hetil. 2002. Vol. 17.143 (46). P. 2579–2585.
11. Maghnie M. Diabetes insipidus // Horm. Res. 2003. Vol. 59 (Suppl.). P. 142–154.
12. McKinley MJ, Jonson AK The physiological regulation of thirst and fluid intake // News Physiol. Sci. 2004. Vol. 19. P. 1–6.
13. Nemergut EC Predictors of diabetes insipidus after transsphenoidal surgery a review of 881 patients // J. Neurosurg. 2005. Vol. 103. P. 448–454.
14. Robertson GL Disorders of Neurohypophysis. // Harrisons Principles of Internal Medicine, edited by Braunwald E., Fauci AS, Kasper DL, Hauser SL, Longo DL, Jameson JL New York: Mc Graw-Hill, 2005. P. 2097–2101.
15. Robinson AG, Verbaliis JG Posterior pituitary. //Ch. 9 in William's textbook of endocrinology, 11th ed. — Saunders, 2000.Vol. 2. P. 263–273.
16. Sheehan JM, Sheehan JP, Douds GL, Page RB DDAVP use in patients undergoing transsphenoidal surgery for pituitary adenomas //Acta Neurochir. (Wien). 2006. Vol. 148(3). P. 287–291.
17. Vande Walle J., Stockner M., Raes A., Norgaard JP Desmopressin 30 years in clinical use: a safety review // Curr. Drug. Saf. 2007. Vol. 2 (3). P. 232–238.
18. Verbalis JG Diabetes insipidus // Rev. Endocr. Metab. Discord. 2003. Vol. 4. P. 177–185.
19. Prager-Khoutorsky M., Bourque CW Osmosensation in vasopressin neurons changing acin density to optimize function // Trends Neurosci. 2010. Vol. 33(2). P. 76–83.

Peculiarities

The disease can be acquired or congenital. The main reason for its development is the inability of the kidneys to respond normally to antidiuretic hormone (ADH). The substance is responsible for the osmotic composition of fluid and water balance in the body. For normal functioning of the body, osmotic balance must be maintained between extracellular fluid and blood (its liquid part).

If osmolarity in the blood plasma increases, a person feels intense thirst, and the production of ADH also increases. In this case, the reabsorption of water in the kidney tubules is disrupted (increased), and the amount of urine decreases.

The diagnosis is determined regardless of the gender or age of the person. There are no deviations in the concentration of sugar in the blood, which is why the disease began to be called “sugar insipidus.” The main symptom of the pathology is constant thirst and increased urine output.

Diabetes insipidus ICD 10 has marker E 23.2. The fact that the number is in the range 00-90 indicates that this pathology is endocrine in nature. Code E 23 - indicates abnormalities in the functioning of the pituitary gland.

Description of the disease

Regulation of water excretion by the kidneys, as well as some other processes in the body, occurs thanks to the hormone vasopressin. It is produced by the hypothalamus, then accumulates in the posterior lobe of the pituitary gland and from there is released into the blood.

Vasopressin is the only regulator of water excretion by the kidneys, and is also involved in the regulation of aggressive human conditions, the contractile function of the muscles of the heart and uterus.

Diabetes insipidus occurs when the hormone is not produced enough, or it is intensely inactivated by vasopressinases that are present and circulating in the blood.

As a result, the process of excretion of water by the kidney tubules is disrupted, the supply of water to cells is reduced and severe thirst is felt against the background of dehydration syndrome.

There are three forms of the disease, with renal diabetes being the most common.

Therapy

Treatment depends on the type of pathology diagnosed, as well as on what pathologies or conditions were the prerequisites for its development.

Central genesis

Therapy of a developed pathological process in the pituitary gland or hypothalamus. First of all, replacement therapy is prescribed, which will make it possible to compensate for the lack of vasopressin. The following methods of administering medications are used:

• injection;
• intranasal;
• oral.

Injections are prescribed for advanced forms of the disease, or when the patient is incapacitated. Thanks to HRT, a person gains the opportunity to lead a full life and maintain work and capacity. But for the renal form of diabetes insipidus, this treatment method will not be effective.

Nephrogenic form

A quick and effective therapy that would guarantee the patient complete healing has not yet been found. Diagnosis of the functioning and presence of pathologies in the kidneys is carried out. Products are selected that reduce inflammation but do not contain steroids.

Diuretic drugs are prescribed, which allows you to slowly and proportionally reduce the volume of urine produced. A special therapeutic diet is selected.

Dipsogenic form

The prerequisite for its development is disruption (damage) of the thirst center, which provokes an abnormal increase in its level. This type often occurs in the form of mental disorders.

Treatment methods:

• anti-inflammatory tablets that do not contain steroids;
• drugs with vasopressin;
• medications that can reduce the amount of urine produced.

Effective therapy for this pathology has not yet been developed.

Gestacin form

It occurs only during pregnancy, so no treatment is required. The pathology goes away on its own after childbirth. The main methods of therapy include diet.

So, if gestational diabetes is detected, the drugs will be as follows:

1. The presence of a neurogenic form of pathology. The main remedy is Desmopressin, a synthetic analogue of vasopressin.
2. Inflammatory nature. Antibiotics, anti-inflammatory and desensitizing medications.
3. Tumors. Surgery, radiotherapy.
4. Presence of an autoimmune component. Treatment is carried out with glucocorticoids. The outcome of therapy will be positive only if the duration of the disease does not exceed 1 year.

Causes

The pathogenesis of the disease is that due to jumps in the amount of glucose in the blood, which puts pressure on the mechanism for regulating urination and urine formation, excessive urination occurs. And when a person stops consuming the proper amount of fluid, dehydration begins and loss of consciousness or coma may occur.

The disease occurs as a result of certain diseases:

• Brain cancer.
• The development of malignant neoplasms (in other words, metastases that appear in the brain).
• Received head injuries.
• Inflammation of the brain (encephalitis).
• Syphilis (a contagious sexually transmitted disease).
• The result of diseases caused by infections entering the body (influenza, ARVI).
• Problematic blood circulation of the pituitary gland or hypothalamus.

It is possible that the disease may be congenital.

As for the second type of disease, namely renal, the reasons for its appearance may be as follows:

• Formation of multiple cysts (polycystic).
• Amyloid deposits in tissues (amyloidosis).
• Renal failure at a chronic level.
• Insufficient amount of calcium in the blood.
• Exceeding potassium levels in the body.
• Taking certain medications that have a negative effect on the kidneys (Demeclocilin, Lithium)
• Sickle cell anemia.
• Elderly age.

To date, no specific and significant reason has been identified that can trigger the occurrence of diabetes insipidus. In 30% of cases it is impossible to find out the cause.